Form

Piel De Miel Waxing Consent Form
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Have you ever been waxed at Piel de Miel before?*
Have you ever been waxed?*
Were you referred by anyone?*
Are you currently pregnant or breastfeeding? (N/A if it does not apply)*
Have you used any Alpha Hydroxy Acids (AHA) products in the last 48-72 hours?*

YesNo
Are you using Retin-a, Tretinoin, Renova or Accutane?*

YesNo
Are you using any skin thinning products and/or drugs?*

YesNo
Do you have any sensitivities or skin concerns with the area(s) being waxed?*
What skin products do you regularly use on your skin?*
Are you currently taking any medications? If so, please list all (this ensures that no medications interfere with waxing and cause skin damage)*
Please note that waxing can cause redness, swelling, tenderness, skin lifting, etc. I have read the information above and if I have any concerns I will address these with the service provider. I have given an accurate account of the questions asked above including all known allergies, prescription drugs or products I am currently ingesting or using orally. I give permission to my esthetician to perform waxing procedures we have discussed and will hold her harmless from any liability that may result from this treatment. I understand that Piel De Miel LLC will take evert precaution to minimize or eliminate negative reactions as much as possible. I understand that I should keep the treated area free of products for 24 hours post-treatment. I am willing to follow recommendations made by my esthetician for a home care regimen that can minimize or eliminate possible negative reactions. In the event that I may have additional questions or concerns regarding my treatment/home care regiment/post-treatment, I will consult with my esthetician immediately. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I certify that i have read, and fully understand the paragraphs above. I do not hold Piel De Miel LLC responsible for any of my conditions that were present , but not disclosed at the time of this skincare procedure, which may be affected by the treatment performed*

I certify that I am at least 18 years of age, agree to the statement above and have reviews Piel de Miel's studio policies upon bookingI am signing as the parent/guardian of an underage client
Date*

MonthDayYear
Signature*

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Name of Parent Consenting

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Piel De Miel Waxing Consent Form